News Briefs

August 26, 2019

✦ Both Centene Corp. and CVS Health Corp.-owned Aetna filed protests after losing their Medicaid plan contracts in Louisiana (HPW 8/19/19, p. 3). Louisiana Healthcare Connections, a subsidiary of Centene, said in an Aug. 19 press release that its protest is based on “multiple conflicts of interest within the evaluation committee, targeted inconsistencies in the scoring of proposals, and the possibility that evaluators may have destroyed public records related to the Medicaid RFP process, among other issues.” Aetna Better Health of Louisiana’s parent company said in a statement that “after careful evaluation of competitor applications and scoring results, we filed a protest letter with LDH [Louisiana Dept. of Health] to appeal the decision.”

To access this post, you must purchase a subscription plan. Click Here to purchase.

✦ Both Centene Corp. and CVS Health Corp.-owned Aetna filed protests after losing their Medicaid plan contracts in Louisiana (HPW 8/19/19, p. 3). Louisiana Healthcare Connections, a subsidiary of Centene, said in an Aug. 19 press release that its protest is based on “multiple conflicts of interest within the evaluation committee, targeted inconsistencies in the scoring of proposals, and the possibility that evaluators may have destroyed public records related to the Medicaid RFP process, among other issues.” Aetna Better Health of Louisiana’s parent company said in a statement that “after careful evaluation of competitor applications and scoring results, we filed a protest letter with LDH [Louisiana Dept. of Health] to appeal the decision.”

To access this post, you must purchase a subscription plan. Click Here to purchase.

New Payment Models for CAR T-cell Treatments Are Years Off

August 22, 2019

On Aug. 7, CMS announced that, effective Oct. 1, it would cover two types of CAR T-cell treatment, which use a patient’s genetically modified immune cells to fight cancer. But private payers continue to reimburse providers for CAR T-cell treatment for patients on a case-by-case basis, experts tell AIS Health, and they expect that trend to continue until this treatment becomes a standard of care. That’s likely to take more than three years.

To access this post, you must purchase a subscription plan. Click Here to purchase.

On Aug. 7, CMS announced that, effective Oct. 1, it would cover two types of CAR T-cell treatment, which use a patient’s genetically modified immune cells to fight cancer. But private payers continue to reimburse providers for CAR T-cell treatment for patients on a case-by-case basis, experts tell AIS Health, and they expect that trend to continue until this treatment becomes a standard of care. That’s likely to take more than three years.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Pediatric Managed Medicaid ACO Touts Role of Pharmacists

August 22, 2019

For a pediatric accountable care organization (ACO) that contracts with Ohio’s Medicaid managed care plans, improving care for children would be a much more difficult job without the expertise of pharmacists who understand the unique needs of those patients.

“Our MCO partners are often really well versed in the adult patient population and chronic diseases that afflict their adult patients — but sometimes the pediatric population’s chronic conditions are different, and those pediatric patients’ needs are much different,” Brigid Groves, a clinical pharmacist specializing in population health at Columbus-based Nationwide Children’s Hospital, tells AIS Health.

To access this post, you must purchase a subscription plan. Click Here to purchase.

For a pediatric accountable care organization (ACO) that contracts with Ohio’s Medicaid managed care plans, improving care for children would be a much more difficult job without the expertise of pharmacists who understand the unique needs of those patients.
“Our MCO partners are often really well versed in the adult patient population and chronic diseases that afflict their adult patients — but sometimes the pediatric population’s chronic conditions are different, and those pediatric patients’ needs are much different,” Brigid Groves, a clinical pharmacist specializing in population health at Columbus-based Nationwide Children’s Hospital, tells AIS Health.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Pipeline of Million-Dollar Drugs Worries Large Employers

August 22, 2019

For large, self-insured U.S. employers, their No. 1 concern related to pharmacy benefits is how to finance treatments that come with seven-figure price tags.

That’s one finding of the National Business Group on Health (NBGH) 2020 Large Employers’ Health Care Strategy and Plan Design Survey, the results of which were unveiled on Aug. 13. Among the 147 employer respondents, 86% said they were either concerned or very concerned about “the impact of million-dollar treatments getting approved by the FDA,” such as Novartis’ $2.1 million spinal muscular atrophy treatment, Zolgensma (onasemnogene abeparvovec-xioi).

To access this post, you must purchase a subscription plan. Click Here to purchase.

For large, self-insured U.S. employers, their No. 1 concern related to pharmacy benefits is how to finance treatments that come with seven-figure price tags.
That’s one finding of the National Business Group on Health (NBGH) 2020 Large Employers’ Health Care Strategy and Plan Design Survey, the results of which were unveiled on Aug. 13. Among the 147 employer respondents, 86% said they were either concerned or very concerned about “the impact of million-dollar treatments getting approved by the FDA,” such as Novartis’ $2.1 million spinal muscular atrophy treatment, Zolgensma (onasemnogene abeparvovec-xioi).

To access this post, you must purchase a subscription plan. Click Here to purchase.

Few Patients Use Obesity Drugs

August 22, 2019

by Jinghong Chen While about 38% of U.S. adults are obese, and the FDA has approved nine drugs to help treat obesity, relatively few people — about 660,000 annually — were estimated to have used an obesity drug between 2012 and 2016, according to a Government Accountability Office (GAO) report released Aug. 9. The GAO […]

To access this post, you must purchase a subscription plan. Click Here to purchase.

by Jinghong Chen While about 38% of U.S. adults are obese, and the FDA has approved nine drugs to help treat obesity, relatively few people — about 660,000 annually — were estimated to have used an obesity drug between 2012 and 2016, according to a Government Accountability Office (GAO) report released Aug. 9. The GAO […]

To access this post, you must purchase a subscription plan. Click Here to purchase.

News Briefs

August 22, 2019

✦ Pharmaceutical manufacturers raised list prices for brand-name prescription drugs by a median of 5% in the first seven months of 2019, down from about 9% or 10% over those months in the prior four years. That’s according to an analysis of drug prices provided to the Associated Press by health information firm Elsevier. Several large manufacturers that are taking heat for high prices — including Pfizer Inc., Novartis International AG, Amgen Inc., AbbVie and Johnson & Johnson — skipped their usual mid-year increases, Elsevier drug pricing expert Kay Morgan told the AP. Nevertheless, there were 37 price hikes for every decrease in the first seven months of 2019.

To access this post, you must purchase a subscription plan. Click Here to purchase.

✦ Pharmaceutical manufacturers raised list prices for brand-name prescription drugs by a median of 5% in the first seven months of 2019, down from about 9% or 10% over those months in the prior four years. That’s according to an analysis of drug prices provided to the Associated Press by health information firm Elsevier. Several large manufacturers that are taking heat for high prices — including Pfizer Inc., Novartis International AG, Amgen Inc., AbbVie and Johnson & Johnson — skipped their usual mid-year increases, Elsevier drug pricing expert Kay Morgan told the AP. Nevertheless, there were 37 price hikes for every decrease in the first seven months of 2019.

To access this post, you must purchase a subscription plan. Click Here to purchase.